Health and Human Services Commission
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Form O
Consolidated Local Service Plan
Local Mental Health Authorities and Local
Behavioral Health Authorities
Fiscal Years 2020-2021 Due Date: September 30, 2020
Submissions should be sent to: [email protected] and [email protected]
Health and Human Services Commission
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Contents Introduction ............................................................................................................................... 3
Section I: Local Services and Needs ................................................................................................. 4
I.A Mental Health Services and Sites ........................................................................................... 4
I.B Mental Health Grant Program for Justice Invovled Individuals ................................................... 6
l.C Community Mental Health Grant Progam ................................................................................ 8
I.D Community Participation in Planning Activities ........................................................................ 8
Section II: Psychiatric Emergency Plan ........................................................................................... 13
II.A Development of the Plan ..................................................................................................... 14
II.B Utilization of Hotline, Role of Mobile Crisis Outreach Teams, and Crisis Response Process ............ 14
II.C Plan for local, short-term management of pre- and post-arrest patients who are incompetent to stand trial ................................................................................................................................. 22
II.D Seamless Integration of emergent psychiatric, substance use, and physical healthcare treatment 24
II.E Communication Plans .......................................................................................................... 25
II.F Gaps in the Local Crisis Response System ............................................................................. 25
Section III: Plans and Priorities for System Development .................................................................. 26
III.A Jail Diversion .................................................................................................................... 26
III.B Other Behavioral Health Strategic Priorities .......................................................................... 30
III.C Local Priorities and Plans .................................................................................................... 35
III.D System Development and Identification of New Priorities ........................................................ 35
Appendix A: Levels of Crisis Care ................................................................................................... 27
Appendix B:
Acronyms..………….…………………………………………………………………………………………………………………………………………..29
Health and Human Services Commission
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Introduction The Consolidated Local Service Plan (CLSP) encompasses all service planning requirements for local
mental health authorities (LMHAs) and local behavioral health authorities (LBHAs). The CLSP has three sections: Local Services and Needs, the Psychiatric Emergency Plan, and Plans and Priorities for System
Development.
The CLSP asks for information related to community stakeholder involvement in local planning efforts. The Health and Human Services Commission (HHSC) recognizes that community engagement is an
ongoing activity and input received throughout the biennium will be reflected in the local plan. LMHAs and LBHAs may use a variety of methods to solicit additional stakeholder input specific to the local plan
as needed. In completing the template, please provide concise answers, using bullet points. Only use the acronyms noted in Appendix B and language that the community will understand as this document is
posted to LMHAs and LBHAs’ websites. When necessary, add additional rows or replicate tables to
provide space for a full response.
Health and Human Services Commission
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Section I: Local Services and Needs
I.A Mental Health Services and Sites
In the table below, list sites operated by the LMHA or LBHA (or a subcontractor organization) providing mental health services regardless of funding. Include clinics and other publicly listed
service sites. Do not include addresses of individual practitioners, peers, or individuals that provide respite services in their homes.
Add additional rows as needed. List the specific mental health services and programs provided at each site, including whether the
services are for adults, adolescents, and children (if applicable): o Screening, assessment, and intake
o Texas Resilience and Recovery (TRR) outpatient services: adults,
adolescents, or children o Extended Observation or Crisis
Stabilization Unit
o Crisis Residential and/or Respite o Contracted inpatient beds
o Services for co-occurring disorders
o Substance abuse prevention,
intervention, or treatment o Integrated healthcare: mental and
physical health o Services for individuals with Intellectual
Developmental Disorders(IDD)
o Services for youth o Services for veterans
o Other (please specify)
Operator (LMHA/LBHA or
Contractor Name)
Street Address, City, and Zip,
Phone Number
County Services & Target Populations Served
LMHA 304 South 22nd
Street, Temple, TX. 76501
Bell Screening, assessment, and intake;
TRR outpatient services (adult); Services for co-occurring disorders;
Integrated healthcare(adult): physical health
Health and Human Services Commission
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Operator
(LMHA/LBHA or Contractor
Name)
Street Address,
City, and Zip, Phone Number
County Services & Target Populations Served
LMHA 317 North 2nd,
Temple, TX. 76501
Bell Screening, assessment, and intake;
TRR outpatient services (children)
LMHA 206 South Central Avenue, Cameron,
TX 76520
Milam Screening, assessments, and intake; TRR outpatient services (adult,
children)
LMHA 806 Avenue D,
Suite E, Copperas
Cove, 76522
Coryell Screening, assessments, and intake;
TRR outpatient services (adult,
children)
LMHA 207 North Lutterloh,
Gatesville, TX. 76528
Coryell TRR outpatient services (adult, children); Screening, assessment, and
intake
LMHA 101 Park Hill,
Hamilton, TX. 76531
Hamilton TRR outpatient services (adult,
children);Screening, assessment, and intake; Services for co-occurring
disorders
LMHA 100 East Avenue,
Killeen, TX. 76541
Bell Screening, assessments, and intake;
TRR outpatient services (adult, children); Services for co-occurring
disorders
LMHA 1305 South Key Avenue, Suite 203,
Lampasas, TX. 76550
Lampasas Screening, assessments, and intake; TRR outpatient services (adult,
children); Services for co-occurring disorders
LMHA 2420 South 37th Street, Temple, TX.
76501
Bell Psychosocial Rehabilitation Services (Adult Day Program)
Health and Human Services Commission
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Operator
(LMHA/LBHA or Contractor
Name)
Street Address,
City, and Zip, Phone Number
County Services & Target Populations Served
I.B Mental Health Grant Program for Justice Involved Individuals
The Mental Health Grant Program for Justice-Involved Individuals is a grant program authorized by Senate
Bill (S.B.) 292, 85th Legislature, Regular Session, 2017, to reduce recidivism rates, arrests, and incarceration among individuals with mental illness, as well as reduce the wait time for individuals on
forensic commitments. These grants support community programs by providing behavioral health care
services to individuals with a mental illness encountering the criminal justice system and facilitate the local cross-agency coordination of behavioral health, physical health, and jail diversion services for
individuals with mental illness involved in the criminal justice system.
In the table below, describe the LMHA or LBHA S.B. 292 projects; indicate N/A if the LMHA or LBHA does not receive funding. Add additional rows if needed.
Health and Human Services Commission
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Fiscal
Year
Project Title (include brief description) County(s) Population
Served
Number
Served per Year
19/20 Temple Day Program (Rehabilitative Services)
Bell Adult Mental
Health 60
19/20 Forensic Assertive Community Treatment Team (All Level of Care Services)
Bell Adult Mental Health/Justice
Involved Individuals
47
19/20 Outpatient Competency Restoration Bell Justice Involved
Individuals
2
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l. C Community Mental Health Grant Program - Projects related to Jail Diversion, Justice
Involved Individuals, and Mental Health Deputies
The Community Mental Health Grant Program is a grant program authorized by House Bill (H.B.) 13, 85th Legislature, Regular Session, 2017. H.B. 13 directs HHSC to establish a state-funded grant program to
support communities providing and coordinating mental health treatment and services with transition or supportive services for persons experiencing mental illness. The Community Mental Health Grant Program
is designed to support comprehensive, data-driven mental health systems that promote both wellness and recovery by funding community-partnership efforts that
provide mental health treatment, prevention, early intervention, and/or recovery services, and assist with persons with transitioning between or remaining in mental health treatment, services, and supports.
In the table below, describe the LMHA or LBHA H.B. 13 projects related to jail diversion, justice involved
individuals and mental health deputies; indicate N/A if the LMHA or LBHA does not receive funding. Add additional rows if needed.
Fiscal
Year
Project Title (include brief description) County Population
Served
Number Served
per Year
2020 N/A
I.D Community Participation in Planning Activities Identify community stakeholders who participated in comprehensive local service planning activities.
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Stakeholder Type Stakeholder Type
☒ Consumers ☒ Family members
☒ Advocates (children and adult) ☒ Concerned citizens/others
☒ Local psychiatric hospital staff
*List the psychiatric hospitals that
participated:
Ross Gaetano, Advent Health
Canaan Blakemore, DNR, Cedar Crest Hospital
☐ State hospital staff
*List the hospital and the staff that
participated:
☒ Mental health service providers
☒ Substance abuse treatment providers
☒ Prevention services providers ☒ Outreach, Screening, Assessment, and Referral Centers
☒ County officials
*List the county and the official name and
title of participants:
Bell County Judge David Blackburn Coryell County Judge Roger Miller
☐ City officials
*List the city and the official name and title
of participants:
☐ Federally Qualified Health Center and other primary care providers
☒
☒
Local health departments
LMHAs/LBHAs
*List the LMHAs/LBHAs and the staff that participated:
Andrea Richardson/Tiffany Gonzalez: Bluebonnet Trails, Disaster Behavioral
Health – Crisis Counseling Program
☒ Hospital emergency room personnel ☒ Emergency responders
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Stakeholder Type Stakeholder Type
☒ Faith-based organizations ☒ Community health & human service providers
☒ Probation department representatives ☒ Parole department representatives
☒ Court representatives (Judges, District Attorneys, public defenders)
*List the county and the official name and title of participants:
Judge Fancy Jezek, Bell County Judge Rebecca Depew, Bell County
☒ Law enforcement
*List the county/city and the official name
and title of participants:
Shawn Reynolds, City of Temple Police
Chief Sargent Eric Fox, Coryell County
Sheriff’s Department Lt. Bob Reinhart, Bell County Sheriff’s
Department Sargent Christopher Ellis, Bell County
Sheriff’s Department
☒ Education representatives ☒ Employers/business leaders
☒ Planning and Network Advisory Committee ☒ Local consumer peer-led organizations
☒ Peer Specialists ☒ IDD Providers
☐ Foster care/Child placing agencies ☒ Community Resource Coordination Groups
☐ Veterans’ organizations ☒ Other: _Central Texas Healthcare Coliation (Disaster Behavioral Health), Bell County
Mental Health Court, Mental Health Taskforce
Describe the key methods and activities used to obtain stakeholder input over the past year, including
efforts to ensure all relevant stakeholders participate in the planning process.
The PNAC met four times over the past fiscal year with opportunities to provide input on key issues
and concerns to include unmet service needs. They reviewed the key issues and concerns to include unmet service needs identified in the 2018 CLSP at their March meeting and concurred
many are still valid.
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Executive and mental health leadership was involved in a number of meetings with stakeholders
over the past year to obtain input on consumer needs and collaborate in developing services utilizing funds from 1115 Waiver 2.0, jail diversion, supportive housing, etc..
The 1115 Waiver Region 8 Health Providers met on a regular basis in the past year to discuss initiatives and activities to meet service requirements.
A local task force with representatives from local hospitals, law enforcement, parole/probation, Bell
County Health District, etc. meets periodically to identify and address unmet needs and gaps in services
List the key issues and concerns identified by stakeholders, including unmet service needs. Only include
items raised by multiple stakeholders and/or had broad support.
Homelessness and lack of local resources
Transportation for individuals for both urgent and routine services. The Hill Country Transit
District (District) is unable to meet the needs of the population we serve especially in the rural and frontier counties. The District reduced their routes in 2017.
Increased substance use/abuse services in the area
Jail diversion for juvenile offenders.
Lack of community resources/providers
Lack of funding for Waiver programs (e.g., YES, AMH-HCS).
Dental Services(no resources available even for those with insurance: Medicaid/Medicare)
Not enough low-income housing (e.g., Section 8 Housing) available. Individuals with fixed incomes
have difficult time finding affordable housing in rural areas)
Lack of crisis beds and state hospital beds
Lack of shelters
Lack of medical insurance
Lack of sustained funding for assistance to pay utilities, rent, etc.
Lack of sufficient local substance abuse services
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Lack of Mental Health Funding to provide residential services for individuals with a mental illness to
include those that are homeless.
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Section II: Psychiatric Emergency Plan
The Psychiatric Emergency Plan is intended to ensure stakeholders with a direct role in psychiatric
emergencies have a shared understanding of the roles, responsibilities, and procedures enabling them to coordinate efforts and effectively use available resources. The Psychiatric Emergency Plan entails a
collaborative review of existing crisis response activities and development of a coordinated plan for how the community will respond to psychiatric emergencies in a way that is responsive to the needs and
priorities of consumers and their families. The planning effort also provides an opportunity to identify and prioritize critical gaps in the community’s emergency response system.
The following stakeholder groups are essential participants in developing the Psychiatric Emergency Plan:
Law enforcement (police/sheriff and jails) Hospitals/emergency departments
Judiciary, including mental health and probate courts Prosecutors and public defenders
Other crisis service providers (to include neighboring LMHAs and LBHAs)
Users of crisis services and their family members Sub-contractors
Most LMHAs and LBHAs are actively engaged with these stakeholders on an ongoing basis, and the plan
will reflect and build upon these continuing conversations.
Given the size and diversity of many local service areas, some aspects of the plan may not be uniform across the entire service area. If applicable, include separate answers for different geographic areas to
ensure all parts of the local service area are covered.
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II.A Development of the Plan (Vincent) Describe the process implemented to collaborate with stakeholders to develop the Psychiatric Emergency Plan, including, but not limited to, the following:
Ensuring all key stakeholders were involved or represented, to include contractors where
applicable;
Key stakeholders identified in Section I. D were involved in the development of the plan.
Ensuring the entire service area was represented; and
Included representatives from the local hospitals, health districts, law enforcement,
courts, parole/probation, etc.
Soliciting input.
Addressing unmet mental health needs specifically crisis/psychiatric emergencies.
II.B Utilization of the Crisis Hotline, Role of Mobile Crisis Outreach Teams (MCOT), and the Crisis Response Process
1. How is the Crisis Hotline staffed?
During business hours
The Center contracts with Avail Solutions to provide Crisis Hotline Services for seven days
a week and 24 hours a day.
After business hours
The Center contracts with Avail Solutions to provide Crisis Hotline Services for seven days
a week and 24 hours a day.
Weekends/holidays
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The Center contracts with Avail Solutions to provide Crisis Hotline Services for seven days
a week and 24 hours a day.
2. Does the LMHA/LBHA have a sub-contractor to provide the Crisis Hotline services? If, yes, please list
the contractor:
Avail Solutions
3. How is the MCOT staffed?
During business hours
Business hours are covered by two staggered shifts (8a.m.-5 p.m. and 12 p.m. -9 p.m.) in two coverage areas (East and West) encompassing our local service area. Daily there are three MCOT workers on both the shifts to complete on-call and walk-in crisis assessments,
SMHF discharge follow-ups, and other client-based services. The Crisis Hotline is also
available 24-hours a day, 7 days a week.
After business hours
After business hours, the second MCOT shift continues to complete on-call crisis assessments until 9p.m.. Night shift coverage then begins 9 p.m.-8 a.m. the next morning for the local
service area. The Crisis Hotline is also available 24-hours a day, 7 days a week.
Weekends/holidays
An MCOT worker is available to complete on-call crisis assessments 24-hours on holidays, and an MCOT worker is also available throughout the weekend. The Crisis Hotline is also
available 24-hours a day, 7 days a week.
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4. Does the LMHA/LBHA have a sub-contractor to provide MCOT services? If yes, please list the
contractor:
No
5. Provide information on the type of follow up MCOT provides (phone calls, face to face visits, case management, skills training, etc.).
MCOT provides follow up services by phone calls, face to face visits in the community or clinic. MCOT will complete an ANSA to see if the individual is eligible for on-going full level of care services and coordinates the transition into on-going services. MCOT will
provide case management and psycho-social rehabilitative services based on the needs of
the individual.
6. Do emergency room staff and law enforcement routinely contact the LMHA/LBHA when an individual in crisis is identified? If so, please describe MCOT’s role for:
Emergency Rooms:
Yes. MCOT staff deploys whenever the emergency rooms contact MCOT to conduct a crisis assessment to determine if psychiatric hospitalization is needed, assist the hospital social
work staff in placing an individual into a SMHF/local psychiatric hospital). MCOT will assist
with coordination of outpatient services and provide follow-up, as needed/requested.
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Law Enforcement:
Yes. MCOT staff deploys whenever law enforcement contact MCOT to conduct a crisis assessment to determine if psychiatric hospitalization is needed, EMS and/or law enforcement would transport the individual to the nearest emergency room to receive
medical clearance. Once clearance is obtained, MCOT would assist the emergency room
as stated above.
7. What is the process for MCOT to respond to screening requests at state hospitals, specifically for walk-ins?
We do not have a SMHF in our local service area where we would be asked to conduct a
crisis assessment.
8. What steps should emergency rooms and law enforcement take when an inpatient level of care is
needed?
During business hours:
Contact the Crisis hotline to request MCOT staff deployment, who will then conduct crisis assessment and place individual on SMHF waiting list as needed/indicated or access a bed at Cedar Crest/Advent Health. Monitoring of individuals on the inpatient care waitlist is
conducted as needed.
After business hours:
Contact the Crisis hotline to request MCOT staff deployment, who will then conduct crisis assessment and place individual on SMHF waiting list as needed/indicated or access a bed at
Cedar Crest/Advent Health. Monitoring of individuals on the inpatient care waitlist is
conducted as needed.
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Weekends/holidays:
Contact the Crisis hotline to request MCOT staff deployment, who will then conduct crisis assessment and place individual on SMHF waiting list as needed/indicated or access a bed at Cedar Crest/Advent Health. Monitoring of individuals on the inpatient care waitlist is
conducted as needed.
9. What is the procedure if an individual cannot be stabilized at the site of the crisis and needs further
assessment or crisis stabilization in a facility setting?
An individual is transported to the nearest appropriate emergency room by EMS and/or law enforcement to receive medical clearance. Once clearance is obtained, MCOT is
called/deployed and completes a crisis assessment and makes a determination for the
need to hospitalize the individual.
10. Describe the community’s process if an individual requires further evaluation and/or medical clearance.
An individual is transported to the nearest appropriate emergency room by EMS and/or law enforcement to receive medical clearance. Once clearance is obtained, MCOT is
called/deployed and completes a crisis assessment and makes a determination for the
need to hospitalize the individual.
11. Describe the process if an individual needs admission to a psychiatric hospital.
MCOT assists the local hospital’s social work staff as needed, to include placing individuals
meeting criteria on the SMHF waiting list or seeks a bed at Cedar Crest or Advent Health.
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12. Describe the process if an individual needs facility-based crisis stabilization (i.e., other than psychiatric
hospitalization and may include crisis respite, crisis residential, extended observation, or crisis stabilization unit).
MCOT assists the local hospital’s social work staff as needed to assist in crisis respite or other placements. There is no facility-based crisis stabilization facility in the local service
area.
13. Describe the process for crisis assessments requiring MCOT to go into a home or alternate location such as a parking lot, office building, school, under a bridge or other community-based location.
MCOT goes into the community to conduct crisis assessments and will contact law enforcement for assistance before entering a potential unsafe environment (person’s
home, under a bridge, parking lot, etc.)
14. If an inpatient bed at a psychiatric hospital is not available: Where does the individual wait for a bed?
The individual is maintained in the emergency room or jail where they were assessed. MCOT continues to provide crisis follow-up and assessment services if the individual is
placed on a SMHF waitlist or cannot access a bed at Cedar Crest or Advent Health.
15. Who is responsible for providing ongoing crisis intervention services until the crisis is resolved or the
individual is placed in a clinically appropriate environment at the LMHA/LBHA?
The individual is maintained in the emergency room or jail where they were assessed.
MCOT continues to provide crisis follow-up and assessment services.
16. Who is responsible for transportation in cases not involving emergency detention?
Mental Health Deputies, family members, private ambulance services, and local
ambulance services are available to transport individuals.
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Crisis Stabilization What alternatives does the local service area have for facility-based crisis stabilization services (excluding inpatient services)? Replicate the table below for each alternative.
Name of Facility
Location (city and county)
Phone number
Type of Facility (see Appendix A)
Key admission criteria (type of
individual accepted)
Circumstances under which medical clearance is required
before admission
Service area limitations, if any
Other relevant admission
information for first responders
Accepts emergency detentions?
Number of Beds
Inpatient Care What alternatives to the state hospital does the local service area have for psychiatric inpatient care for
uninsured or underinsured individuals? Replicate the table below for each alternative.
Name of Facility Cedar Crest Hospital
Location (city and county) Belton, Texas (Bell County)
Phone number (254) 613-9871
Key admission criteria Danger to self or others due to psychosis.
Service area limitations, if any None
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Other relevant admission
information for first responders
Mental Health Deputies and law enforcement coordinate with MCOT
for admission.
Number of Beds 68
Is the facility currently under
contract with the LMHA/LBHA to purchase beds?
Yes
If under contract, is the facility contracted for rapid crisis
stabilization beds (funded under the Psychiatric Emergency
Service Center contract or Mental
Health Grant for Justice-Involved Individuals), private psychiatric
beds, or community mental health hospital beds (include all
that apply)?
Private Psychiatric Beds
If under contract, are beds
purchased as a guaranteed set or on an as needed basis?
As needed basis
If under contract, what is the bed
day rate paid to the contracted facility?
$675
If not under contract, does the LMHA/LBHA use facility for
single-case agreements for as needed beds?
N/A
If not under contract, what is the
bed day rate paid to the facility for single-case agreements?
N/A
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Name of Facility Advent Health Hospital
Location (city and county) Killeen, Texas (Bell County)
Phone number (254) 526-7523
Key admission criteria Danger to self or others due to psychosis
Service area limitations, if any None
Other relevant admission
information for first responders
Mental Health Deputies and law enforcement coordinate with MCOT
for admission.
Number of Beds 29
Is the facility currently under
contract with the LMHA/LBHA to purchase beds?
Yes
If under contract, is the facility contracted for rapid crisis
stabilization beds (funded under the Psychiatric Emergency
Service Center contract or Mental
Health Grant for Justice-Involved Individuals), private psychiatric
beds, or community mental health hospital beds (include all
that apply)?
Private Psychiatric Beds
If under contract, are beds
purchased as a guaranteed set or on an as needed basis?
As needed basis
If under contract, what is the bed
day rate paid to the contracted facility?
$675
If not under contract, does the LMHA/LBHA use facility for
N/A
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single-case agreements for as
needed beds?
If not under contract, what is the
bed day rate paid to the facility for single-case agreements?
N/A
II.C Plan for local, short-term management of pre- and post-arrest individuals who are deemed incompetent to stand trial What local inpatient or outpatient alternatives to the state hospital does the local service area currently
have for competency restoration? If not applicable, enter N/A.
Identify and briefly describe available alternatives.
Outpatient Competency Restoration.
What barriers or issues limit access or utilization to local inpatient or outpatient alternatives?
Transportation and Housing for individuals upon release
Does the LMHA or LBHA have a dedicated jail liaison position? If so, what is the role of the jail liaison and at what point is the jail liaison engaged?
The Center has a dedicated jail liaison position that coordinates with the jails and Mental Health Bell County Court to assist in providing interventions to decrease mental health admissions and readmissions to criminal justice settings such as jails or prisons. The jail
liaison supervises a Forensic Assertive Community Treatment Team and a Day Rehabilitation Program to help individuals at risk of admission into jails. The Center has a
contract with Bell County to provide navigation services (e.g., screening, booking,
discharge, etc.) as part of the Sandra Bland Act requirements. The jail liaison supervises
the two jail navigators housed at Bell County jail.
If the LMHA or LBHA does not have a dedicated jail liaison, identify the title(s) of employees
who operate as a liaison between the LMHA or LBHA and the jail.
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N/A
What plans, if any, are being developed over the next two years to maximize access and utilization of local alternatives for competency restoration?
None, program exists. The Center plans to continue to educate county officials about the program and collaborate with the courts in the decision-making process to streamline the
OCR admission process.
Does the community have a need for new alternatives for competency restoration? If so, what
kind of program would be suitable (i.e., Outpatient Competency Restoration Program inpatient competency restoration, Jail-based Competency Restoration, etc.)?
Jail-based Competency Restoration
What is needed for implementation? Include resources and barriers that must be resolved.
Award of funds from HHSC grant application. Need space in the jail for competency
restoration (e.g., crisis respite).
II.D Seamless Integration of emergent psychiatric, substance use, and physical healthcare treatment and the development of Certified Community Behavioral Health Clinics (CCBHCs)
1. What steps have been taken to integrate emergency psychiatric, substance use, and physical healthcare services? Who did the LMHA/LBHA collaborate with in these efforts?
The Center has a APRN on staff providing specific physical healthcare services as part of
the 1115 Waiver project and future CCBHC program.
2. What are the plans for the next two years to further coordinate and integrate these services?
The Center plans to add substance use services and more physical healthcare services in
the next two years as part of obtaining CCBHC certification.
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II.E Communication Plans
1. What steps have been taken to ensure key information from the Psychiatric Emergency Plan is shared with emergency responders and other community stakeholders?
The Center shares information with the Bell County Health Task Force, Bell County Mental Health Deputy meetings, Coryell County Mental Health Deputies, and with other
emergency responders through similar consolidated community provider meetings.
2. How will the LMHA or LBHA ensure staff (including MCOT, hotline, and staff receiving incoming telephone calls) have the information and training to implement the plan?
Key LMHA staff will receive information and training on how to implement the plan.
II.F Gaps in the Local Crisis Response System
What are the critical gaps in the local crisis emergency response system? Consider needs in all parts of the local service area, including those specific to certain counties.
County Service System Gaps Recommendations to Address the Gaps
Hamilton,
Lampasas, Milam
Few to no certified mental health
deputies in law enforcement.
Seek additional funds to provide
training.
Bell, Coryell, Hamilton,
Lampasas, Milam
No crisis stabilization units outside of emergency rooms or inpatient
psychiatric hospitals. No extended observation units and crisis
respite/residential services
Seek additional funds to provide services.
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Hamilton Hamilton County Hospital does not
provide behavioral health services.
Seek additional funds to coordinate the
provision of behavioral health services with Hamilton County Hospital.
Section III: Plans and Priorities for System Development
III.A Jail Diversion
The Sequential Intercept Model (SIM) informs community-based responses to the involvement of
individuals with mental and substance use disorders in the criminal justice system. The model is most effective when used as a community strategic planning tool to assess available resources, determine
gaps in services, and plan for community change. A link to the SIM can be accessed here:
https://www.prainc.com/wp-content/uploads/2017/08/SIM-Brochure-Redesign0824.pdf
In the tables below, indicate the strategies used in each intercept to divert individuals from the criminal
justice system and indicate the counties in the service area where the strategies are applicable. List current activities and any plans for the next two years.
Intercept 0: Community
Services Current Programs and Initiatives:
County(s)
Plans for upcoming two years:
MCOT and Mental Health
Deputies
Bell, Coryell Seek funds to continue with
Mental Health Deputy Program in Bell and Coryell
County when the 1115 Waiver program ends.
https://www.prainc.com/wp-content/uploads/2017/08/SIM-Brochure-Redesign0824.pdf
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Intercept 1: Law Enforcement Current Programs and Initiatives:
County(s) Plans for upcoming two years:
Co-mobilization with Crisis Intervention Team and MH
Deputies and MCOT staff as requested/needed.
Bell, Coryell Will continue to work with Crisis Intervention Teams
(CIT) and MH Deputies as long as there is funding for
the CIT
Diagnostic/behavioral training with Bell and Coryell County
CIT/Deputies by LPHA/Intake Diagnosticians.
Bell, Coryell Will continue to offer training as requested.
As requested training with Bell County judge, court personnel,
and court-affiliated Social Work
staff
Bell Will continue to offer training as requested
“Fast-track” intake procedure
and resource referrals for individuals referred by law
enforcement staff.
Bell, Coryell Continue.
When MH Deputies come into contact and divert an individual
they will notify Center MCOT for further follow up services and
possible assessment for intake into Center outpatient care.
Bell, Coryell Continue
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Intercept 3: Jails/Courts
Current Programs and Initiatives:
County(s)
Plans for upcoming two years:
Active participation with the
Bell County MH court to assist with jail diversions.
Bell Continue
“Fast-track” intake procedure
and resource referrals for individuals referred by the
courts.
Bell Continue
Bell and Coryell Mental Health
Deputies are called into their
respective jails in order to assess inmates with diversion
eligible charges for evidence of mental illness.
Bell, Coryell Continue
Bell County has an Indigent Defense program separate from
LMHA (Center). As a part of their Mental Health court, the
Center has a representative present at court to aid in
reviewing cases.
Bell Continue
Forensic Assertive Community Treatment (FACT) team
services available to facilitate comprehensive services.
All Counties in the Local Service Area
Continue
Lampasas County Jail Screens
Inmates for Mental Health History, those who screen
positive are referred to the Lampasas AMH office for
Lampasas Continue
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Medication Related Services at
a Fee for Service rate. Medications are provided by the
Jail.
The jail navigators will continue
to conduct mental health screenings during the booking
process and follow inmate through the discharge process
to link the individuals to services in the community.
Bell Continue
Intercept 4: Reentry Current Programs and Initiatives:
County(s) Plans for upcoming two years:
•Navigator Services Bell •The navigators will continue to
work the Well Path (healthcare contractor with Bell County Jail)
with continuity of care planning for inmates.
• •
Intercept 5: Community
Corrections Current Programs and Initiatives:
County(s)
Plans for upcoming two years:
• Center currently provides Continuity of Care services to TCOOMMI referred mentally ill
offenders. Offenders are assessed and linked to LMHA services. Many
offenders are admitted into
All counties in the local
service area.
•Continue
30
routine MH services while others
are referred to TCOOMMI COC programs in their residence
county upon completing services in this area. We conduct meetings
with Parole as well as maintain communication with Probation
Departments in the local service area.
• •
III.B Other Behavioral Health Strategic Priorities
The Texas Statewide Behavioral Health Strategic Plan identifies other significant gaps and goals in the
state’s behavioral health services system. The gaps identified in the plan are: Gap 1: Access to appropriate behavioral health services for special populations (e.g., individuals
with co-occurring psychiatric and substance use services, individuals who are frequent users of
emergency room and inpatient services) Gap 2: Behavioral health needs of public school students
Gap 3: Coordination across state agencies Gap 4: Veteran and military service member supports
Gap 5: Continuity of care for individuals exiting county and local jails Gap 6: Access to timely treatment services
Gap 7: Implementation of evidence-based practices Gap 8: Use of peer services
Gap 9: Behavioral health services for individuals with intellectual disabilities Gap 10: Consumer transportation and access
Gap 11: Prevention and early intervention services Gap 12: Access to housing
https://hhs.texas.gov/sites/default/files/050216-statewide-behavioral-health-strategic-plan.pdf
31
Gap 13: Behavioral health workforce shortage
Gap 14: Services for special populations (e.g., youth transitioning into adult service systems) Gap 15: Shared and usable data
The goals identified in the plan are:
Goal 1: Program and Service Coordination - Promote and support behavioral health program and service coordination to ensure continuity of services and access points across state agencies.
Goal 2: Program and Service Delivery - Ensure optimal program and service delivery to maximize
resources in order to effectively meet the diverse needs of people and communities. Goal 3: Prevention and Early Intervention Services - Maximize behavioral health prevention and
early intervention services across state agencies.
Goal 4: Financial Alignment - Ensure that the financial alignment of behavioral health funding best meets the needs across Texas.
Goal 5: Statewide Data Collaboration – Compare statewide data across state agencies on results and effectiveness.
In the table below briefly describe the current status of each area of focus as identified in the plan (key accomplishments, challenges and current activities), and then summarize objectives and activities
planned for the next two years.
Area of Focus Related
Gaps and Goals from
Strategic Plan
Current Status Plans
Improving access to
timely outpatient services
Gap 6
Goal 2
In progress Continue to ensure 10
business day rule is intact. Center has
opened another clinic in Copperas Cove to help
improve access
32
Area of Focus Related
Gaps and Goals from
Strategic Plan
Current Status Plans
Improving continuity
of care between inpatient care and
community services and reducing hospital
readmissions
Gap 1
Goals 1,2,4
Hospital liaison
coordinates with local psychiatric hospitals
and Center service providers to link
individuals to community services
upon discharge.
Continue
Transitioning long-
term state hospital patients who no
longer need an
inpatient level of care to the community
and reducing other state hospital
utilization
Gap 14
Goals 1,4
UM monitors long
term patients. Challenges to
transition to the
community are immigration status,
need to establish guardianship, lack of
activities of daily living, and the lack of
financial resources for healthcare services or
residential placement.
Continue to monitor and
coordinate with the SMHF for accessing
community resources.
Implementing and ensuring fidelity with
evidence-based practices
Gap 7
Goal 2
Most Center service programs have fidelity
with evidence-based practices. QM uses
the fidelity toolkits to
Center direct care service providers will be
trained in EBPs and the MH Program Specialist
will provide the
33
Area of Focus Related
Gaps and Goals from
Strategic Plan
Current Status Plans
monitor the
implementation of EBPs.
necessary follow-up
training. QM will continue to monitor EBP
services and notify MH if there are outliers.
Transition to a recovery-oriented
system of care, including use of peer
support services
Gap 8
Goals 2,3
Center has peer support specialist who
provide services based on the recovery-
oriented system of care.
Continue
Addressing the needs
of consumers with co-occurring
substance use disorders
Gaps 1,14
Goals 1,2
Center employees are
trained in COPSD and provides those
services
The Center is preparing
to provide substance use services as a
CCBHC provider in the future.
Integrating
behavioral health and primary care
services and meeting physical healthcare
needs of consumers.
Gap 1
Goals 1,2
The Center has a
primary care nurse practitioner who
provides limited services as part of the
1115 Waiver program outcomes.
The Center is preparing
to provide more comprehensive primary
care services as a CCBHC provider in the
future.
34
Area of Focus Related
Gaps and Goals from
Strategic Plan
Current Status Plans
Consumer
transportation and access to treatment in
remote areas
Gap 10
Goal 2
Center assist
Medicaid recipients in accessing medical
appointment transportation. ACT
transports consumers, if needed. Temple Day
Program transports individuals to their
program.
Continue
Addressing the
behavioral health
needs of consumers with Intellectual
Disabilities
Gap 14
Goals 2,4
MH and IDD
coordinates behavioral
support (psychiatric medical services)
appointment with Center prescribers for
individuals enrolled in Medicaid Waivers.
Some individuals with IDD and MH diagnosis
receives MH services.
Continue
Addressing the behavioral health
needs of veterans
Gap 4
Goals 2,3
Center provides veterans services
through a contract with BEITZ.
Center is preparing to provide veterans
services as a CCBHC provider in the future.
35
III.C Local Priorities and Plans Based on identification of unmet needs, stakeholder input, and internal assessment, identify the top
local priorities for the next two years. These might include changes in the array of services, allocation
of resources, implementation of new strategies or initiatives, service enhancements, quality improvements, etc.
List at least one but no more than five priorities. (CCBHC) For each priority, briefly describe current activities and achievements and summarize plans for the
next two years. If local priorities are addressed in the table above, list the local priority and enter “see
above” in the remaining two cells.
Local Priority Current Status Plans
CCBHC Complete application process Operationalize CCBHC
III.D System Development and Identification of New Priorities Development of the local plans should include a process to identify local priorities and needs and the resources required for implementation. The priorities should reflect the input of key stakeholders
involved in development of the Psychiatric Emergency Plan as well as the broader community. This builds on the ongoing communication and collaboration LMHAs and LBHAs have with local stakeholders.
The primary purpose is to support local planning, collaboration, and resource development. The information provides a clear picture of needs across the state and support planning at the state level.
In the table below, identify the local service area’s priorities for use of any new funding should it become
available in the future. Do not include planned services and projects that have an identified source of funding. Consider regional needs and potential use of robust transportation and alternatives to hospital
care. Examples of alternatives to hospital care include residential facilities for non-restorable individuals, outpatient commitments, and other individuals needing long-term care, including geriatric patients with
mental health needs. Also consider services needed to improve community tenure and avoid
hospitalization.
36
Provide as much detail as practical for long-term planning and: Assign a priority level of 1, 2 or, 3 to each item, with 1 being the highest priority;
Identify the general need; Describe how the resources would be used—what items/components would be funded, including
estimated quantity when applicable; and Estimate the funding needed, listing the key components and costs (for recurring/ongoing costs, such
as staffing, state the annual cost.
Priority Need Brief description of how resources
would be used
Estimated Cost
1 Example: Detox Beds
Establish a 6-bed detox unit at ABC Hospital.
2 Example: Nursing home care
Fund positions for a part-time psychiatrist and part-time mental health professionals to support staff at ABC Nursing Home in
caring for residents with mental illness. Install telemedicine equipment in ABC
Nursing Facility to support long-distance psychiatric consultation.
3 EOU Funds to be used to partner with local hospital to establish an EOU
Unknown
2 Reduce re-occurring
hospitalizations
Develop a multi-organizational team to reduce individuals meeting Center eligibility
criteria from using the local emergency rooms for mental health care by linking
those individuals to Center MH outpatient services.
$175,000
37
Appendix A: Levels of Crisis Care
Admission criteria – Admission into services is determined by the individual’s level of care as determined by the TRR Assessment found here for adults or here for children and adolescents. The TRR
assessment tool is comprised of several modules used in the behavioral health system to support care planning and level of care decision making. High scores on the TRR Assessment module, such as items
of Risk Behavior (Suicide Risk and Danger to Others) or Life Domain Functioning and Behavior Health Needs (Cognition), trigger a score that indicates the need for crisis services.
Crisis Hotline – The Crisis Hotline is a 24/7 telephone service that provides information, support, referrals, screening and intervention. The hotline serves as the first point of contact for mental health
crisis in the community, providing confidential telephone triage to determine the immediate level of need and to mobilize emergency services if necessary. The hotline facilitates referrals to 911, MCOT, or other
crisis services.
Crisis Residential Units– provide community-based residential crisis treatment to individuals with a moderate to mild risk of harm to self or others, who may have fairly severe functional impairment, and
whose symptoms cannot be stabilized in a less intensive setting. Crisis residential facilities are not authorized to accept individuals on involuntary status.
Crisis Respite Units –provide community-based residential crisis treatment for individuals who have low risk of harm to self or others, and who may have some functional impairment. Services may occur
over a brief period of time, such as two hours, and generally serve individuals with housing challenges or assist caretakers who need short-term housing or supervision for the persons they care for to avoid
mental health crisis. Crisis respite facilities are not authorized to accept individuals on involuntary status.
Crisis Services – Crisis services are brief interventions provided in the community that ameliorate the crisis and prevent utilization of more intensive services such as hospitalization. The desired outcome is
resolution of the crisis and avoidance of intensive and restrictive intervention or relapse.
Crisis Stabilization Units (CSU) – are the only licensed facilities on the crisis continuum and may
accept individuals on emergency detention or orders of protective custody. CSUs offer the most intensive
https://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/behavioral-health-provider/um-guidelines/trr-utilization-management-guidelines-adult.pdfhttps://hhs.texas.gov/sites/default/files/documents/doing-business-with-hhs/provider-portal/behavioral-health-provider/um-guidelines/trr-utilization-management-guidelines-child.pdf
38
mental health services on the crisis facility continuum by providing short-term crisis treatment to reduce
acute symptoms of mental illness in individuals with a high to moderate risk of harm to self or others.
Extended Observation Units (EOU) – provide up to 48-hours of emergency services to individuals in
mental health crisis who may pose a high to moderate risk of harm to self or others. EOUs may accept individuals on emergency detention.
Mobile Crisis Outreach Team (MCOT) – MCOTs are clinically staffed mobile treatment teams that provide 24/7, prompt face-to-face crisis assessment, crisis intervention services, crisis follow-up, and
relapse prevention services for individuals in the community.
Psychiatric Emergency Service Center (PESC) – PESCs provide immediate access to assessment,
triage and a continuum of stabilizing treatment for individuals with behavioral health crisis. PESC projects include rapid crisis stabilization beds within a licensed hospital, extended observation units,
crisis stabilization units, psychiatric emergency service centers, crisis residential, and crisis respite and are staffed by medical personnel and mental health professionals that provide care 24/7. PESCs may be
co-located within a licensed hospital or CSU or be within proximity to a licensed hospital. The array of projects available in a service area is based on the local needs and characteristics of the community and
is dependent upon LMHA/LBHA funding.
Rapid Crisis Stabilization and Private Psychiatric Beds – Hospital services staffed with medical and nursing professionals who provide 24/7 professional monitoring, supervision, and assistance in an
environment designed to provide safety and security during acute behavioral health crisis. Staff provides intensive interventions designed to relieve acute symptomatology and restore the individual’s ability to
function in a less restrictive setting.
39
Appendix B: Acronyms
CSU Crisis Stabilization Unit
EOU Extended Observation Units HHSC Health and Human Services Commission
LMHA Local Mental Health Authority LBHA Local Behavioral Health Authority
MCOT Mobile Crisis Outreach Team PESC Psychiatric Emergency Service Center
